Keith S. Kaye, MD, MPH; N. Deborah Friedman, MBBS; Daniel J. Sexton, MD
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Kaye KS, Friedman ND, Sexton DJ. Health Care–Associated Bloodstream Infections. Ann Intern Med. 2003;139:233. doi: 10.7326/0003-4819-139-3-200308050-00013
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Published: Ann Intern Med. 2003;139(3):233.
The primary objective of our study was to develop a new classification scheme for bloodstream infection that distinguishes among community-acquired and health care–associated bloodstream infections. Dr. Zetola states that subgroups within the health care–associated category we proposed have not been proven to be associated with infection caused by antimicrobial-resistant bacteria and that use of unnecessary broad-spectrum antibiotics might harm patients by leading to resistance. The most significant antimicrobial-resistant pathogen isolated in our study was methicillin-resistant S. aureus (MRSA). This was the infecting pathogen in 19% of patients with health care–associated bacteremia and 20% of patients with nosocomial bacteremia but only 2% of patients with community-acquired bacteremia. Moreover, MRSA bacteremia occurred in all subgroups of the health care–associated category, including recently hospitalized patients; those receiving home intravenous therapy or nursing care, dialysis, or chemotherapy; and those in nursing homes. Enterobacteriaceae resistant to ampicillin–sulbactam or ciprofloxacin were infrequently cultured. However, they were recovered with similar frequency in nosocomial settings (18 of 40 patients [45%] and 2 of 40 patients [5%], respectively) and health care–associated settings (17 of 45 patients [38%] and 5 of 45 patients [11%], respectively) and less frequently in community settings (11 of 58 patients [19%] and 0 of 58 patients [0%], respectively).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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